CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan)

Medication Therapy Management

The Medication Therapy Management (MTM) Program is an additional service that is available for free to eligible CareAdvantage CMC members with certain medical conditions. This program helps you and your doctor make sure that your medications are working. It also helps us identify and reduce possible medication problems. Enrollment is voluntary and does not affect Medicare coverage for drugs covered under Medicare. The program's benefits include:

Targeted Medication Review (TMR)

At least quarterly, we will review all your prescription medications and contact you and/or your doctor by phone or mail if we detect a potential problem.

Comprehensive Medication Review (CMR)

At least once a year, you get a free review and 30-minute discussion of all of your medications (including over-the-counter products) by a pharmacist or other health professional. The CMR:

  • Is a confidential discussion either by telephone or in person at your provider’s office, pharmacy or long-term care facility. If you or your caregiver are not able to participate in the CMR, this review may be completed directly with your provider.
  • Identifies if you are taking duplicate medicines and any potential problems with taking medicines together.
  • Can help you organize your medications, making it easier to know what to take when.
  • Is provided through pharmacies operated by SinfoníaRx, the University of Arizona Medication Management Center, The Ohio State University College of Pharmacy Medication Management Program or other University programs.

After Your CMR

Following the CMR, you get a written summary of the discussion that includes:

  • A Medication Action Plan with steps you can take to get the best results from your medications.
  • A Personal Medication List to help you keep track of your medications and how to use them correctly.

Eligibility

The MTM program is not considered a benefit, and is required by the Centers for Medicare and Medicaid Services (CMS) which (in part) sets the criteria for participation. HPSM identifies eligible program participants on a monthly basis. We then send letters to eligible individuals inviting them to join the program. If you take multiple medications for more than one chronic health condition, you may be eligible for the MTM program. Please contact the CareAdvantage Unit to learn more.

To take part in the MTM program, you must meet all of the following three criteria:

  1. Take at least three drugs covered by Medicare Part D.
  2. Have expected Medicare Part D drug costs greater than $3,967 per year.
  3. Have a diagnosis of at least two of the following medical conditions:
  • Acid / Reflux / Ulcers
  • Anticoagulation
  • Asthma
  • Arthritis
  • Atrial Fibrillation
  • Cancer
  • Cardiovascular Disorders
  • Cerebrovascular Disease
  • Chronic Alcohol Dependence
  • Chronic Drug Dependence
  • Chronic Heart Failure (CHF)
  • Chronic Lung Disorders
  • Chronic Noncancer Pain
  • Dementia
  • Diabetes
  • Dyslipidemia
  • End-Stage Renal Disease (ESRD)
  • Hepatitis C
  • HIV/AIDS
  • Hypertension
  • Osteoarthritis
  • Osteoporosis
  • Rheumatoid
  • Stroke

CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Limitations and restrictions may apply. For more information, call the CareAdvantage Unit or read the CareAdvantage CMC Member Handbook.

Benefits and co-pays may change on January 1 of each year.

If you speak other languages other than English, language assistance services, free of charge, are available to you. Call 1-866-880-0606 (TTY: 1-800-735-2929). (Download this statement in multiple languages.)


H7885_MMP_15129_01_18_EN Approved

Page updated August 14, 2018